Falls Flashcards
define a fall
unexpected event in which the participant comes to rest on the ground or floor
list some reasons why older people are more likely to fall
sarcopenia smaller pupils - less light getting in reduced cardio fitness reduce reaction time increased postural sway reduced bone and joint stability
list some intrinsic risk factors for falls
medical conditions
cognitive impairments
impaired vision and hearing
age related changed to posture and gait
list some medical conditions that increase falls risks
diabetes leading to peripheral neuropathy
Parkinsons and stroke affecting balance and gait
incontinence leading to needing to rush to toilet
arthritis
vision problems/incorrect glasses
obesity
list some extrinsic risk factors for falls
medications
environmental - rugs
inadequate lighting
inappropriate footwear
list some medications that the side effects can increase risk of falls
antihypertensives diuretics sedatives/benzos anticholingergics hypoglycaemic agents
the fear of falling increases risk of falls true/false
true - cautious gait develops and this reduces length of stride
which type of glasses are associated with the greatest falls risk
bifocals and varifocals
which medications can cause orthostatic hypotension
anticonvulsants
antidepressants
antihypertensives
benzodiazepines
which medications can cause sedation/drowsiness
anticonvulsants
antidepressants
benzodiazepines
which medications can cause syncope
beta-blockers
nitrates
vasodilators such as alpha-blockers
which medications can cause visual disturbances
anticholingergics
stopping psychotropic drugs will greatly reduce falls risk true/false
true - particularly venlafaxine, risperidone, haloperidol
a BP of what reading is associated with increased falls in the elderly
110mmHg systolic
which antihypertensives are protective in cardiac failure and which antihypertensives should be stopped if orthostatic hypotension is present
ACEi and beta-blockers are protective
NICE recommends stopping nitrates, CCBs and vasodilators
list clinical features of significant peripheral neuropathy
loss of heel reflexes
decreased vibratory sense that improves proximally
inability to maintain unipedal stance for 10 seconds
outline the management of orthostatic hypotension
stop any culprit drugs
tell patient to avoid sudden changes in posture
water loading
increase salt intake
potentially compression stockings
elevate legs when sitting/sleeping
if conservative management fails, consider fludrocortisone
outline the elements of a falls examination
general observations bony injury to vertebrae, hips or pelvis postural BP or murmur gait neuro exam visual exam AMTS or MOCA
what is the best management for reducing falls risk
balance and strength exercises such as Tai Chi
